HEAD START/EARLY HEADSTART ENROLLMENT …

G:\ERSEA\Forms\Head start \Head start - early Head start ENROLLMENT Application Revised. 1/11/17 HEAD start & early HEAD start ENROLLMENT APPLICATION THE CHILD S INFORMATION EHS-CCP EHS HS LIFT Child s Legal Name First Middle Initial Last Child s Place of Birth (City, State) Child s DOB (mm/dd/yyyy) Sex Child s Ethnicity Latino Yes No Child s Race Pacific Islander Black White Biracial/ Multi Nat. Amer. Asian Other_____ Child s Primary Language English Spanish Vietnamese Other _____ Child s Secondary Language English Spanish Vietnamese Other _____ THE CHILD S HOUSEHOLD FAMILY INFORMATION 1 Primary adult name Latino? Yes No Primary Language if different from child Secondary Language if Different from child Race 2 Secondary adult (if any) Latino?

G:\ERSEA\Forms\Head Start\Head Start-Early Head Start Enrollment Application English.doc Revised. 1/11/17 First & Last Name of Children in Home

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  Applications, Early, Start, Heads, Enrollment, Head start early headstart enrollment, Headstart, Head start early head start enrollment application

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